Exercise and Type 2 Diabetes

Exercise and Type 2 Diabetes


Yes, the current guidelines by the American Diabetes Association (ADA) recommend that all adults with prediabetes and diabetes engage in regular physical activity.1,2 This recommendation comes from multiple studies showing that exercise, along with other lifestyle changes, can prevent or delay the onset of type 2 diabetes (T2D) and help manage the illness.



Physical activity helps lower the risk of and manage T2D through mainly weight loss and improved glycemic control (blood glucose level management).3

Weight Loss – By reducing intra-abdominal fat that exacerbates insulin resistance, physical activity can delay the onset of and manage T2D.4 Obesity is the strongest risk factor for T2D, and the ADA recommends the combination of physical activity, diet, and behavioral therapy to achieve a 5% weight loss for overweight or obese individuals with T2D (a sustained weight loss of >7% is considered optimal).1 Strong evidence suggests that losing 5% of initial body weight for overweight or obese individuals lowers the need for blood-sugar lowering medication by improving glycemic control.

Glycemic Control – Meta-analyses evaluating the effects of exercise interventions have shown that physical activity can improve glycemic control in T2D patients even without significant weight loss.5,6 Moderate-intensity physical activity increases blood flow to skeletal muscles, (increasing delivery), increases muscle glucose uptake capacities (increasing consumption), and increases enzymatic activities related to glucose metabolism (increasing metabolism).7  Furthermore, one meta-analysis found that patient who engaged in aerobic training had significantly reduced glycosylated hemoglobin (HbA(1c)) levels – an indicator of long-term glycemic control8 – when compared to patients who did not.5 Past studies have reported that a 1% decrease in HbA(1c) level, even without weight loss, is associated with a 37% decrease in microvascular complications and a 15-20% decrease in major cardiovascular disease events in individuals with T2D.9–11



The ADA advises that adults with prediabetes and diabetes engage in at least 2.5 hours of aerobic activity every week.1 The exercise should be of at least moderate intensity and should be performed over a period of at least 3 days, with no more than 2 consecutive days of inactivity. Additionally, studies suggest that engaging in both aerobic and resistance training may be more effective in managing T2D than engaging in one type of exercise alone.9,12,13

Here are some ways you can get started:1,2

  • Set clear goals: use the SMART approach to set a goal that is specific, measurable, achievable, realistic, and time-bound (eg, “I will take a brisk walk for 20 minutes at 8:00AM before work, 3 times a week, for at least one month”)
  • Avoid a sedentary lifestyle: try to avoid sitting for more than 1.5 hours straight and take frequent breaks to walk around
  • Start small: start with 10 minutes of exercise you personally enjoy (eg, brisk walks, dancing, bicycling, etc.) and gradually increase the duration
  • Incorporate exercise into your daily life: think of ways to be more active in your daily routine (eg, try to take the stairs instead of the elevator, try to walk instead of drive, etc.)
  • Track your progress: find a way to track your daily physical activity and progress over time as this can encourage long-term lifestyle changes


1. Standards of Medical Care in Diabetes—2016 Abridged for Primary Care Providers. Clin Diabetes Publ Am Diabetes Assoc. 2016;34(1):3-21. doi:10.2337/diaclin.34.1.3
2. Koenigsberg MR, Corliss J. Diabetes Self-Management: Facilitating Lifestyle Change. Am Fam Physician. 2017;96(6):362-370.
3. Lao XQ, Deng HB, Liu X, et al. Increased leisure-time physical activity associated with lower onset of diabetes in 44 828 adults with impaired fasting glucose: a population-based prospective cohort study. Br J Sports Med. 2019;53(14):895-900. doi:10.1136/bjsports-2017-098199
4. Galicia-Garcia U, Benito-Vicente A, Jebari S, et al. Pathophysiology of Type 2 Diabetes Mellitus. Int J Mol Sci. 2020;21(17):6275. doi:10.3390/ijms21176275
5. Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA. 2001;286(10):1218-1227. doi:10.1001/jama.286.10.1218
6. Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care. 2006;29(11):2518-2527. doi:10.2337/dc06-1317
7. Richter EA, Derave W, Wojtaszewski JFP. Glucose, exercise and insulin: emerging concepts. J Physiol. 2001;535(Pt 2):313-322. doi:10.1111/j.1469-7793.2001.t01-2-00313.x
8. Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomark Insights. 2016;11:95-104. doi:10.4137/BMI.S38440
9. Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2010;304(20):2253-2262. doi:10.1001/jama.2010.1710
10. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405-412. doi:10.1136/bmj.321.7258.405
11. Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2004;141(6):421-431. doi:10.7326/0003-4819-141-6-200409210-00007
12. Sigal RJ, Kenny GP, Boulé NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med. 2007;147(6):357-369. doi:10.7326/0003-4819-147-6-200709180-00005
13. Grøntved A, Rimm EB, Willett WC, Andersen LB, Hu FB. A prospective study of weight training and risk of type 2 diabetes mellitus in men. Arch Intern Med. 2012;172(17):1306-1312. doi:10.1001/archinternmed.2012.3138



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